The Martinsburg Marlins Swim Team 2016 Registration Form

The Martinsburg Marlins Swim Team 2016 Registration Form
Family Name________________________ Parent/Guardian Names_________________________________________
Home Address____________________________________________________________________________________
E-mail Address/es_________________________________________________________________________________
List the name and direct contact numbers of guardians or emergency contacts. Write W, H or C to identify Work/Home/Mobile.
Name________________________Relationship___________________Phone #_______________________
Name________________________Relationship___________________Phone #_______________________
Name________________________Relationship___________________Phone #_______________________
Name________________________Relationship___________________Phone #_______________________
Swimmer # l Full Name_________________________________________NickName__________________________
Birthdate__/___/_____Age as of 6/1/16____ /T-Shirt Size ____/Grade-Fall 2016____/ # Years in Competitive Swim____
Medication/Conditions/Concerns ______________________________Circle ONE: Advanced / Intermediate / Emergent / Pre-Competitive
Swimmer # 2 Full Name________________________________________NickName__________________________
Birthdate__/___/_____Age as of 6/1/16_____/T-Shirt Size ____/Grade-Fall 2016____/ # Years in Competitive Swim____
Medication/Conditions/Concerns ______________________________Circle ONE: Advanced / Intermediate / Emergent / Pre-Competitive
Swimmer # 3 Full Name________________________________________NickName__________________________
Birthdate__/___/_____Age as of 6/1/16_____/T-Shirt Size ____/Grade-Fall 2016____/ # Years in Competitive Swim____
Medication/Conditions/Concerns ______________________________Circle ONE: Advanced / Intermediate / Emergent / Pre-Competitive
Swimmer # 4 Full Name________________________________________NickName__________________________
Birthdate__/___/_____Age as of 6/1/16_____/T-Shirt Size ____/Grade-Fall 2016____/ # Years in Competitive Swim____
Medication/Conditions/Concerns ______________________________Circle ONE: Advanced / Intermediate / Emergent / Pre-Competitive
Photo Release (optional): I hereby grant the Martinsburg Marlins Swim Team permission to photograph child/ren and his/her swimming during the
swim season. Photographs may be used on the team’s social media sites, in newsletters or other printed publications without further consideration. I
permit the Martinsburg Marlins to modify the photographs at its discretion and allow the organization to use such photography for future promotions of
the swim team and will not request or be honored entitlements, royalties or compensation of any sort.
Parent/Guardian Printed Name/Signature X_______________________________________________________Date___________
Medical Release: I hereby grant permission for emergency first aid to be administered to my child/ren in the event an injury occurs. If deemed
necessary, I grant permission for my child/ren to be transported to the nearest emergency medical facility. I authorize the medical staff at that facility to
provide treatment deemed necessary by the physician on duty to promote the health, safety and well-being of my child/ren.
Preferred Physician/Insurance Co. (optional) __________________________________________Physician’s Phone #__________________________
Parent/Guardian Printed Name/Signature X_______________________________________________________Date___________
Liability Waiver: As the parent/legal guardian of the above named minor/s, I grant permission for the swimmers listed above to participate in all
activities of this sport program. I assume all risks and hazards incidental to such participation, including transportation to and from activities. I waive all
claims and hereby release, absolve, indemnify and agree to hold harmless the Martinsburg/Berkeley County Parks and Recreation board, the
Martinsburg Marlins Board of Directors, the Interstate Swim league, coaches, officials, volunteers, organizers, supervisors, participants and such
persons transporting my child to and from activities for any claim arising out of injury to any liability insurance carried by such person or organization.
Parent/Guardian Printed Name/Signature X_______________________________________________________Date___________
Parent/Guardian Agreement: I agree to the terms of the parent and swimmer codes of conduct and hereby commit to uphold its expectations for all
my participants and guests attending team-related activities. I understand that I must volunteer my services as assigned or send a competent proxy
to each event unless excused in advance by the team’s volunteer coordinator. An operational deposit of $50 per household will be required upon
registration. If the minimum requirement of volunteering during more than half of the season’s scheduled meets is met, the deposit will be returned at
the end of the season; however, if the minimum volunteering requirement is not met, the deposit will not be refunded and shall be retained by the
Martinsburg Marlins Swim Team. I understand and agree that the head coach and the board of directors have the final authority on which practice and
events swimmers shall participate in. I hold full responsibility for staying updated with team-related events via TeamApp. I agree to register for a free
account on TeamApp and request to be a member of the Martinsburg Marlins TeamApp page. I understand that I must play an active role in
communicating with the coaches via Martinsburg Marlins TeamApp page by responding to each event with my plans for attendance and will use the
app to advise the coaches of my absences 3 days in advance. I understand that violation and/or non-compliance of any of the codes of conduct or the
parent handbook may result in expulsion from the team for registered swimmers and/or dismissal from events for parents, guardians and guests. I
agree that no refund or reduction in fees of any sort will be sought by me, my guests or family members, nor will it be granted by the Martinsburg
Marlins Swim Team, its Board of Directors or any office of the Martinsburg-Berkeley County Parks and Recreation Authority or any of its affiliates.
Parent/Guardian Printed Name/Signature X_______________________________________________________Date___________
Swimming Grant (Optional):
I would like to donate $________toward a grant to help swimmers in need.
I would like to request at grant.
The Martinsburg Marlins Board of Directors will review grant requests and determine award amounts on a case-by-case basis.
Contact [email protected] for questions or visit us during on-site registration.
REGISTRATION FEES:
$120 (May 14th ONLY) 
$135 (May 15-5/28 ONLY) 
$150 5/30/16-6/10/16
Checks should be payable to MBCPR (Martinsburg-Berkeley County Parks & Recreation) Memo-Martinsburg Marlins Swim Team
EARLY-BIRD REGISTRATION-$120 Mail-In: Postmarked by 5/14/16 On-Site: 10am-1pm on 5/14/16 in the lobby of the Marshall Mason Wing at
MBCPR-273 Woodbury Avenue, Martinsburg, WV. Team suits, swim gear and other items will be available for purchase at this time.
OPEN REGISTRATION-$135 Mail-in: Postmarked May 15th-28th ON-SITE: Lambert Pool May 24th-28th 4:30pm-5:30pm M-F or Saturday, 9am-10am.
LATE REGISTRATION-$150 Mail-In: Not Accepted. ON-SITE ONLY at Lambert Pool during weekday practices only, May 30th-June-10th, 8-10 am.
REGISTER BY MAIL: Early and open registrations received by mail must be postmarked by the deadlines listed above in order to receive discounted
rates. To complete registration by mail, send your signed registration form, Parent Code of Conduct, Swimmer Code of Conduct, Registration Fee &
Volunteer deposit to: Martinsburg Marlins, c/o M.Veilleux, 15 McNeill Dr. Martinsburg, WV 25403. (Checks or Money Orders only. No cash, please.)
A $5 discount will apply to registrations of children living in the same household who complete their registrations on the same day one full-price
registration is submitted. No swimmer will enter the pool for practice without completing the registration process. No refund will be given to registrants
who elect not to participate. Refund requests for medical withdrawals are at the discretion of MBCPR and are not guaranteed.
FOUO: PARENT CC
SWIMMER CC
# REGISTRANTS______ REGISTRATION DATE__ _/_ __/16 APPROVER’S INITIALS________
TOTAL REGISTRATION FEES $_______________
CASH CHECK#_________ VOLUNTEER DEPOSIT $50
CASH CHECK#_________